中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2009年
1期
20-24
,共5页
视神经炎%多发性硬化%视神经脊髓炎%磁共振成像
視神經炎%多髮性硬化%視神經脊髓炎%磁共振成像
시신경염%다발성경화%시신경척수염%자공진성상
Optic neuritis%Multiple sclerosis%Neuromyelitis optica%Magnetic resonance imaging
目的 了解特发性脱髓鞘性视神经炎(IDON)临床转归、转化为多发性硬化(MS)或视神经脊髓炎(NMO)的比例以及相关影响因素.方法 对确诊且临床资料完整的IDON患者进行病例回顾及随访,记录视功能和其他神经功能变化以及MS或NMO转化率,应用卡方检验分析不同临床特征对转化率的影响.结果 共入组资料完整且完成随访的IDON患者107例.多数患者视力恢复较好,12例(11.2%)在随访期间转化为MS或NMO.全部12例患者均符合2005年修订的McDonald诊断标准,其中4例符合1999年NMO诊断标准,其余8例中部分表现为"视神经脊髓型MS".复发性IDON较首次发病患者、伴头颅MRI异常较MRI正常者转化为MS或NMO的比例高,分别为23.1%和4.4%(χ2=6.899,P<0.01)以及18.2%和8.1%.是否伴有视乳头水肿以及不同视力损害程度组之间转化为MS或NMO的比例没有差异.结论 该组IDON患者转化为MS或NMO的比例为11.2%.复发性IDON和伴有头颅MRI异常的患者更易转化为MS或NMO.
目的 瞭解特髮性脫髓鞘性視神經炎(IDON)臨床轉歸、轉化為多髮性硬化(MS)或視神經脊髓炎(NMO)的比例以及相關影響因素.方法 對確診且臨床資料完整的IDON患者進行病例迴顧及隨訪,記錄視功能和其他神經功能變化以及MS或NMO轉化率,應用卡方檢驗分析不同臨床特徵對轉化率的影響.結果 共入組資料完整且完成隨訪的IDON患者107例.多數患者視力恢複較好,12例(11.2%)在隨訪期間轉化為MS或NMO.全部12例患者均符閤2005年脩訂的McDonald診斷標準,其中4例符閤1999年NMO診斷標準,其餘8例中部分錶現為"視神經脊髓型MS".複髮性IDON較首次髮病患者、伴頭顱MRI異常較MRI正常者轉化為MS或NMO的比例高,分彆為23.1%和4.4%(χ2=6.899,P<0.01)以及18.2%和8.1%.是否伴有視乳頭水腫以及不同視力損害程度組之間轉化為MS或NMO的比例沒有差異.結論 該組IDON患者轉化為MS或NMO的比例為11.2%.複髮性IDON和伴有頭顱MRI異常的患者更易轉化為MS或NMO.
목적 료해특발성탈수초성시신경염(IDON)림상전귀、전화위다발성경화(MS)혹시신경척수염(NMO)적비례이급상관영향인소.방법 대학진차림상자료완정적IDON환자진행병례회고급수방,기록시공능화기타신경공능변화이급MS혹NMO전화솔,응용잡방검험분석불동림상특정대전화솔적영향.결과 공입조자료완정차완성수방적IDON환자107례.다수환자시력회복교호,12례(11.2%)재수방기간전화위MS혹NMO.전부12례환자균부합2005년수정적McDonald진단표준,기중4례부합1999년NMO진단표준,기여8례중부분표현위"시신경척수형MS".복발성IDON교수차발병환자、반두로MRI이상교MRI정상자전화위MS혹NMO적비례고,분별위23.1%화4.4%(χ2=6.899,P<0.01)이급18.2%화8.1%.시부반유시유두수종이급불동시력손해정도조지간전화위MS혹NMO적비례몰유차이.결론 해조IDON환자전화위MS혹NMO적비례위11.2%.복발성IDON화반유두로MRI이상적환자경역전화위MS혹NMO.
Objective To investigate the clinical prognosis of idiopathic demyelinating optic neuritis (IDON), the rate of its conversion to multiple sclerosis (MS) or neuromyelitis optica (NMO) and its clinical features related to the conversion.Methods Patients satisfying our entry criteria for IDON hospitalized in Beijing Tongren Hospital during the period from 2002 to 2007 were re-evaluated with follow-ups for 6-months to 5-years.The McDonald diagnostic criteria for MS (revised, 2005) was used to diagnose MS in these subjects during follow-up and the diagnosis of NMO utilized 1999 Wingerchuk' s NMO criteria.The Chi-Squared χ2 test was applied to statistically analyze association of clinical features and development of MS or NMO.Results In 107 recruited IDON cases with complete clinical data and follow-up, 12 cases (11.2%) developed into MS or NMO during follow-up period.All 12 cases met the revised McDonald criteria, of which 4 cases met NMO criteria and the remaining eight cases showed some clinical evidence of "optic-spinal MS (OS-MS)".A significantly higher conversion rate of 23.1% was found in recurrent IDON than the 4.4% in single-episode cases (χ2 = 6.899, P < 0.01) .Convesion rate of female patiends (17.2%) is significantly higher than male patients (4.1%, χ2 = 4.620, P < 0.05).Conversion rate of 18.2% in patients with initially abnormal brain MRI was higher than rate of 8.1% in cases with normal brain MRI, but the difference was not statistically significant.No difference was found between presence or absence of swollen disc, nor severity of vision loss.Conclusions In a group of IDON patients, 11.2% developed into MS and NMO or clinically indicative OS-MS.Recurrent IDON and female gender suggested higher risk of developing MS or NMO.
